title: HSV-2 Infection as a Cause of Female/Male and Racial/Ethnic Disparities in HIV Infection.
abstract: To examine the potential contribution of herpes simplex virus 2 (HSV-2) infection to female/male and racial/ethnic disparities in HIV among non-injecting heroin and cocaine drug users. HSV-2 infection increases susceptibility to HIV infection by a factor of two to three.
  
  
  
  Subjects were recruited from entrants to the Beth Israel drug detoxification program in New York City 2005-11. All subjects reported current use of heroin and/or cocaine and no lifetime injection drug use. A structured questionnaire was administered and serum samples collected for HIV and HSV-2 testing. Population-attributable risk percentages (PAR%s) were calculated for associations between HSV-2 infection and increased susceptibility to HIV.
  
  
  
  1745 subjects were recruited from 2005-11. Overall HIV prevalence was 14%. Females had higher prevalence than males (22% vs. 12%) (p<0.001), African-Americans had the highest prevalence (15%), Hispanics an intermediate prevalence (12%), and Whites the lowest prevalence (3%) (p<.001). There were parallel variations in HSV-2 prevalence (females 86%, males 51%, African-Americans 66%, Hispanics 47%, Whites 36%), HSV-2 prevalence was strongly associated with HIV prevalence (OR  =  3.12 95% CI 2.24 to 4.32). PAR%s for HSV-2 as a cause of HIV ranged from 21% for Whites to 50% for females. Adjusting for the effect of increased susceptibility to HIV due to HSV-2 infection greatly reduced all disparities (adjusted prevalence  =  males 8%, females 11%; Whites 3%, African-Americans 10%, Hispanics 9%).
  
  
  
  Female/male and racial/ethnic variations in HSV-2 infection provide a biological mechanism that may generate female/male and racial/ethnic disparities in HIV infection among non-injecting heroin and cocaine users in New York City. HSV-2 infection should be assessed as a potential contributing factor to disparities in sexually transmitted HIV throughout the US.
authors.affiliation: Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, United States of America.
authors.forename: Don C
authors.initials: DC
authors.lastname: Des Jarlais
authors.forename: Kamyar
authors.initials: K
authors.lastname: Arasteh
authors.forename: Courtney
authors.initials: C
authors.lastname: McKnight
authors.forename: David C
authors.initials: DC
authors.lastname: Perlman
authors.forename: Hannah L F
authors.initials: HL
authors.lastname: Cooper
authors.forename: Holly
authors.initials: H
authors.lastname: Hagan
mesh_terms: D000328:Adult; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000150:complications*; D054624:Health Status Disparities; D006558:Herpes Genitalis / Q000150:complications*; D018258:Herpesvirus 2, Human / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D044469:Racial Groups